Evaluating the management capacity in primary health services by private sector at local public health system

Evaluating the Management Capacity in  Primary  Health Services by Private Sector at Local Public Health System
Cristina Maria Meira de Melo. Professor at Nursing School of Universidade Federal da Bahia. cmmelo@uol.com.br. 

Heloniza O. G. Costa. 

Geovana Raimunda Silva Santana. 

Handerson Silva Santos.

A State Reform process in Brazil changed its health system and services management. In this context, the management of primary health services was delegated to private organizations since 2004 by the Public Health System, in Salvador, Bahia, one of the largest cities in the country. With this background, a research to evaluate management capacity of public primary health services with emergency room was developed. Based upon qualitative and quantitative conceptions, the research consisted of four cases studies. Integrality and completeness of care and existence of social control, guidelines of the National Health System were used to define the indicators, parameters and categories of analyses. The management capacity was evaluated from three dimensions: organizational, witch measures the model of the decision-making process; operational, measuring the capacity to operate the services; and sustainability, measuring the capacity to articulate partnership to continuous implementation of the decisions made in the management process. Data were collected through questionnaires applied to health workers and clients of the health service, interviews with managers and documental analysis. The plan of indicators was analyzed with a scale of four degrees were punctuation was obtained when the indicator obtained at least 25% of positive answer. All data were analyzed based in local context. The good results of the organizational dimension could be partly attributed to the support of the private organization responsive for the management contract to health service manager. The fragile results of the others two dimensions were related with manager profile; lack of articulation with others health services; problems with the compromise of the municipality with the management contract; lack of social control and the political and administrative turbulence in the local context. The results indicated that this model do not assure better management services to the population, as affirmed by the defenders of this model.